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Cited by 23Pain Mechanisms and TreatmentsPain Management and TreatmentMusculoskeletal pain and rehabilitation

Evaluation of a scoring system for the detection of central sensitization among women with chronic pelvic pain

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Cardaillac, Claire, Levesque, Amélie, Riant, Thibault, Mortier, Anaïs, Neunlist, Michel, Perrouin-Verbe, Marie-Aimée, Volteau, Christelle, Thubert, Thibault +2 more·2023·American Journal of Obstetrics and Gynecology
DOI 10.1016/j.ajog.2023.07.044
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Abstract

Background Central sensitization is frequently associated with chronic pelvic pain and requires specific management. The pain is described as hypersensitivity to an innocuous stimulus that is both widespread and persistent. However, no study has evaluated if central sensitization can be measured objectively with neurophysiological tests in the pelvic and perineal area to prove this concept in women with chronic pelvic pain.Objective This study aimed to evaluate nociceptive thresholds (primary objective) and spatial and temporal diffusion of pain among women with chronic pelvic pain and high or low scores of central sensitization.Study design This prospective, assessor-blinded, comparative study compared a cohort of women with chronic pelvic pain and a high (>5/10; n=29) vs low (<5/10; n=24) score of sensitization according to the Convergences PP criteria. Participants underwent a noninvasive bladder sensory test, a rectal barostat test, and a muscular (algometer) and a vulvar (vulvagesiometer) sensory test. Poststimulation pain (minutes), quality of life (Medical Outcomes Study 36-Item Short Form Survey), and psychological state, comprising anxiety (State-Trait Anxiety Inventory), depression (Beck Depression Inventory Short Form), and catastrophizing (Pain Catastrophizing Scale), were assessed.Results The participants mostly suffered from endometriosis (35.8%), irritable bowel syndrome (35.8%), bladder pain syndrome (32.1%), and vestibulodynia (28.3%). Baseline characteristics were similar. Women with a high sensitization score had more painful diseases diagnosed (2.7±1.3 vs 1.6±0.8; P=.002) and suffered for longer (11±8 vs 6±5 years; P=.028) than participants with a low score. The bladder maximum capacity was equivalent between participants (399±168 vs 465±164 mL; P=.18). However, the pain felt at each cystometric threshold was significantly increased in women with a high sensitization score. No difference was identified for the rectal pain pressure step (29.3±5.5 vs 30.7±6.5 mm Hg; P=.38). Rectal compliance was decreased in women with a high sensitization score with a considerable increase in pain felt. The average of pain pressure thresholds at the 5 vulvar sites tested was decreased in these participants (162.5±90.5 vs 358.7±196.5 g; P=.0003). Similar results were found for the average of the pain pressure thresholds at 6 muscles tested (1.34±0.41 vs 2.63±1.52 kg/m 2; P=.0002). A longer period was needed for patients with high sensitization score to obtain a VAS <3 out of 10 after the stimulation of the bladder (4.52±5.26 vs 1.27±2.96 minutes; P=.01), the rectum (3.75±3.81 vs 1.19±1.23 minutes; P=.009), and the muscles (1.46±1.69 vs 0.64±0.40 minutes; P=.002). The psychological state was equivalent between groups. No association was found between the sensory thresholds and the psychological state results. The physical component of the quality of life score was reduced in women with high sensitization score (P=.0005), with no difference in the mental component.Conclusion Using neurophysiological tests, this study showed that there are objective elements to assess for the presence of central sensitization, independently of psychological factors.

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  • Residual adenomyosis and peripheral and central sensitization influence autonomous nerve function and have implications for GI function.

    “Residual adenomyosis and peripheral and central sensitization has been shown to influence autonomous nerve function and will therefore also have implications on GI function. 41 , 42”

    From Gastrointestinal function outcomes following radical and conservative colorectal surgery for deep endometriosis: A systematic review and meta‐analysis (2025) · cites this paper as [41]

    The Comment section reports lower rectal compliance and greater pain during rectal distension in women with high sensitization scores, supporting an association between central sensitization and a GI-related measure. The paper does not show that residual adenomyosis or peripheral sensitization alters autonomic nerve function, or establish autonomic change as the mechanism for GI effects (searched for those terms and mechanisms). (LLM, conf=0.86)

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  • The lack of relevant differences in changes of GI function following segmental resection and conservative surgery may be explained by postsurgical GI function not solely depending on surgical technique but on the degree of overall radicality of removal of disease including adenomyosis and deep endometriosis affecting other sites.

    “First and foremost, postsurgical GI function may not solely depend on the surgical technique but on the degree of overall radicality of removal of disease including adenomyosis and DE affecting other sites.”

    From Gastrointestinal function outcomes following radical and conservative colorectal surgery for deep endometriosis: A systematic review and meta‐analysis (2025) · cites this paper as [41]

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Research works printed but not linked: 1

  1. [4]4. Quistrebert-Davanne V, Hardouin JB, Riant T, Ploteau S, Rigaud J, Levesque A. Psychometric validation of Convergence criteria PP. Prog Urol 2021;31:1192-200.

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Authors
Cardaillac, C., Levesque, A., Riant, T., Mortier, A., Neunlist, M., Perrouin-Verbe, M.-A., Volteau, C., Thubert, T., Brochard, C., & Ploteau, S.
Affiliations
  • Inserm (FR)
  • Centre Hospitalier Universitaire de Nantes (FR)
Corresponding author
Ploteau, Stéphane
ORCID
Venue
American Journal of Obstetrics and Gynecology
Publisher
Elsevier BV
Published
2023-11
Volume
229
Issue
5
Pages
530.e1-530.e17
ISSN
0002-9378 (ISSN-L)
DOI
10.1016/j.ajog.2023.07.044
OpenAlex
W4385323839
Cited by
23
References
31
Citations by year
2026: 6 · 2025: 7 · 2024: 8 · 2023: 2
FWCI
4.06
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Obstetrics and Gynecology (acceptedVersion)
  • PubMed (publishedVersion)
  • HAL (submittedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Keywords
central sensitization, chronic pelvic pain, nociceptive threshold, pain catastrophizing, anxiety, depression, quality of life, endometriosis, irritable bowel syndrome, interstitial cystitis, vestibulodynia, women's health
MeSH terms
Female, Humans, Pain Measurement, Prospective Studies, Quality of Life, Pelvic Pain, Central Nervous System Sensitization, Chronic Pain

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